Outcomes in Patients with Left Ventricular Assist Devices, Pacemakers, and Implantable Cardioverter Defibrillators Undergoing Single Balloon Enteroscopy

Objectives: Obscure overt gastrointestinal bleeding can be challenging to evaluate in patients with electronic cardiac devices such as continuous flow left ventricular assist devices (LVADs), pacemakers (PPMs), and implantable cardioverter defibrillators (ICDs). Limited data exist on the utility and safety of single balloon enteroscopy (SBE) in patients with cardiac...

An Underappreciated and Prolonged Drug Interaction Leads to Ineffective Anticoagulation

A poorly understood significant drug–drug interaction compounded by ineffective communication among providers at times of care transition most likely contributed to multiple thromboembolic events in an 81-year-old patient. Increased awareness of drug interactions with direct oral anticoagulants (DOACs), as well as improved communication among inpatient and outpatient providers at...

CME Article: Imaging in Acute Pyelonephritis: Utilization, Findings, and Effect on Management

Objectives: To determine the frequency, timing, and types of imaging obtained in patients with a discharge diagnosis of acute pyelonephritis, and how often imaging findings affect therapy. Methods: This was a retrospective chart review of 1062 adults with a diagnosis of acute pyelonephritis discharged from an urban, safety-net hospital...

Cancer Risk Awareness among Uninsured Primary Care Patients

Objectives: Underserved populations are at risk of low cancer risk awareness. The purpose of this study was to examine cancer risk awareness and lifestyle issues among uninsured primary care patients in the United States. Methods: Data were collected using a self-administered survey from May to July 2017 of adult...

Can C-Reactive Protein Be Used to Predict Acute Septic Arthritis in the Adult Population?

Objectives: The objective of this study was to establish whether C-reactive protein (CRP) could be used to predict native joint septic arthritis (SA) in the adult population. Methods: All patients who underwent native joint aspiration in accident and emergency settings between April 2012 and September 2016 were identified from...

Radiologic versus Endoscopic Placement of Gastrostomy Tube: Comparison of Indications and Outcomes at a Tertiary Referral Center

Objectives: Percutaneous gastrostomy tube placement is performed in patients requiring long-term enteral nutrition. Although both endoscopic and fluoroscopic techniques may be used, there are inherent risks and potential complications associated with both procedures that are not generally known to referring physicians. The purpose of this study was to compare...

Influences on Primary Care Provider Imaging for a Hypothetical Patient with Low Back Pain

Objective: How outside factors affect physician decision making remains an open question of vital importance. We sought to investigate the importance of various influences on physician decision making when clinical guidelines differ from patient preference. Methods: An online survey asking 469 primary care providers (PCPs) across four practice sites...

Demographic and Practice Characteristics of Physicians Who Care for Medically Underserved People: A National Survey

Objectives: Few national studies have examined the influence of role models as a potential predictor for caring for medically underserved (MUS) patients. This study tested associations between previous physician role model exposure and caring for MUS populations, as well as examines the practice environments of these physicians. Methods: Between...

Uremic Pericarditis: Distinguishing Features in a Now-Uncommon Clinical Syndrome

We present the case of a 47-year-old man with a history of diabetes mellitus and diabetic nephropathy who was admitted to our hospital with acute uremic myopericarditis. Echocardiography demonstrated a fibrinous pericardial effusion. The patient was initiated on hemodialysis for hyperkalemia, metabolic acidosis, and uremia. He subsequently developed shock...

Prevalence and Impact of Diabetes Mellitus on the Frozen Shoulder

Objectives: The objective of this study was to estimate the prevalence of undiagnosed diabetes mellitus in patients with newly diagnosed frozen shoulder (FS) and study whether diabetes mellitus increases the severity of FS disease. Methods: Patients with newly diagnosed FS were consecutively included in this case-control study. Patients who...

Role of Rifaximin in Spontaneous Bacterial Peritonitis Prevention

Cirrhosis affects millions of people around the world and is associated with increased morbidity and mortality. Spontaneous bacterial peritonitis (SBP) is a common complication of liver disease with cirrhosis and accounts for up to 30% of infections in patients with cirrhosis. Patients with a history of SBP and those...

Late-Stage Melanoma: Be Sure to Screen Uninsured, Unmarried Men

Objective: The purpose of this study was to assess for any associations between individual and social factors and late-stage melanoma in Kentucky from 1995 to 2013. Methods: The study combines three datasets: individual-level data from the Kentucky Cancer Registry, census tract–level data from the US Census, and county-level physician...

Group Battlefield Acupuncture in Primary Care for Veterans with Pain

Objective: To obtain preliminary data on the short- and intermediate-term effects of battlefield acupuncture (BFA) on self-reported pain intensity in a relatively large cohort of veterans to assess whether a more comprehensive clinical trial evaluation is warranted. Methods: The treatment, in an outpatient group setting, consisted of up to...

Mobile Health (mHealth) Use or Non-Use by Residents of West Virginia

Objective: To compare mobile health (mHealth) usage by residents of West Virginia with national estimates. Methods: Pew Research Center data from its Internet and American Life Project were accessed for secondary data analysis. These data, available to the public, are a probability sample of Internet use in the United...

Risk, Outcomes, and Predictors of Clostridium difficile Infection in Lymphoma: A Nationwide Study

Objective: The risk of Clostridium difficile infection (CDI) has not been well studied in patients with lymphoma. We thus sought to determine the risk of CDI in hospitalizations with lymphoma along with its trend, outcomes, and predictors using a large database. Methods: Hospital discharge data from the Nationwide Inpatient...

Uric Acid Control in Advanced Chronic Kidney Disease in a Southeastern US Urban Cohort

Objectives: Uric acid (UA) control may be insufficient in chronic kidney disease (CKD) patients in the current era. It is unclear, however, whether this is the result of environmental effects, patient anthropometrics or insufficient dosing of medical therapy (allopurinol). Methods: We have collected data on multiple clinical and laboratory...

OPEN ACCESS: Association Between System Factors and Acute Myocardial Infarction Mortality

Objectives: We conducted a cross-sectional study to assess the association between healthcare system factors and death from acute myocardial infarction (AMI), in terms of access (distance to the hospital, mode of transportation), availability (emergency medical services, hospitals), and capability (emergency medical services’ 12-lead electrocardiogram capability, continuous percutaneous coronary intervention...

Association Between the Frank Sign and Cardiovascular Events

Clinicians have attempted to find early preclinical physical diagnosis signs to detect vascular diseases at the preclinical stage and to prevent clinical deterioration in time. An interesting example of such signs is the Frank sign, which was first described by Dr Sonders T. Frank in 1973. Our goal was...

ICD Discussions: Closing the Gap between What We Say and What They Understand

More than 20 million adults worldwide have a diagnosis of heart failure (HF).1 The prevalence in the United States is expected to increase by 46% from 2012 to 2030, resulting in an increase from 5 million to 8 million Americans living with this condition.2 Approximately 50% of people diagnosed...

OPEN: Effects of Long-Term Combination LT4 and LT3 Therapy for Improving Hypothyroidism and Overall Quality of Life

Objectives: Hypothyroidism results in decreased mood and neurocognition, weight gain, fatigue, and many other undesirable symptoms. The American Association of Clinical Endocrinologists, the American Thyroid Association (ATA), and The Endocrine Society recommend levothyroxine (LT4) monotherapy as the treatment for hypothyroidism; however, after years of monotherapy, some patients continue to...